Efficacy of Mobile Instant Messaging–Delivered Brief Motivational Interviewing for Parents to Promote Physical Activity in Pediatric Cancer Survivors
Authors: Ankie Tan Cheung, William Ho Cheung Li, Laurie Long Kwan Ho, Godfrey Chi-Fung Chan, Huen Sum Lam, Joyce Oi Kwan Chung
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Physical activity has beneficial effects that mitigate cancer- and treatment-related late effects. However, children who survive cancer are often physically inactive. Brief motivational interviewing may be an effective approach for increasing children's physical activity levels. <h3>Objective</h3> To examine the effects of mobile instant messaging–delivered brief motivational interviewing for parents in promoting regular physical activity in children who have survived cancer. <h3>Design, Setting, and Participants</h3> An assessor-blinded randomized clinical trial was conducted at 2 Hong Kong pediatric oncology outpatient clinics from March 1, 2019, to January 29, 2021. A total of 161 children who had survived cancer, aged 9 to 16 years, and their parents were randomized (1:1) to an intervention or control group. <h3>Interventions</h3> The intervention group received a 6-month mobile instant messaging–delivered brief motivational interviewing using a strategy menu. Parent-child dyads in both groups received a health advice session and were directed to a physical activity website at baseline. <h3>Main Outcomes and Measures</h3> The primary outcome was the children's physical activity levels at 12-month follow-up, measured by the Chinese University of Hong Kong: Physical Activity Rating for Children and Youth (total sores: 0-10, higher scores indicate greater physical activity levels). Secondary outcomes were cancer-related fatigue levels, handgrip strength, peak expiratory flow rate, and quality of life. Intention-to-treat analysis was performed. <h3>Results</h3> Of the 161 children included in the study, 93 were boys (57.8%), and the mean (SD) age was 12.4 (2.4) years. Generalized estimating equation analyses showed a significant improvement in outcomes in the intervention group compared with the control group: physical activity levels (group-by-time interaction, 6 months: β = 3.09; 95% CI, 2.65-3.53;<i>P</i> &lt; .001; 12 months: β = 3.91; 95% CI, 3.45-4.36;<i>P</i> &lt; .001), cancer-related fatigue (6 months: β = −5.69; 95% CI, −8.03 to −3.35;<i>P</i> &lt; .001; 12 months: β = −9.16; 95% CI, −11.31 to −7.00;<i>P</i> &lt; .001), left handgrip strength (6 months: β = 2.69; 95% CI, 0.96-4.43;<i>P</i> = .002; 12 months: β = 5.52; 95% CI, 3.70-7.33;<i>P</i> &lt; .001), right handgrip strength (6 months: β = 2.75; 95% CI, 1.01-4.50;<i>P</i> = .002; 12 months: β = 5.45; 95% CI, 3.62-7.27;<i>P</i> &lt; .001), peak expiratory flow rate (12 months: β = 28.51; 95% CI, 16.10-40.92;<i>P</i> &lt; .001), and quality of life (6 months: β = 5.01; 95% CI, 1.19-8.82;<i>P</i> = .01); 12 months: β = 14.19; 95% CI, 10.84-17.54;<i>P</i> &lt; .001). <h3>Conclusions and Relevance</h3> In this randomized clinical trial, mobile instant messaging–delivered brief motivational interviewing was effective in promoting the adoption and maintenance of regular physical activity and ameliorating cancer- or treatment-related adverse effects in children who survived cancer. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT03859271